Powrót do strony głownej  <<  Powrót do listy szablonów

ref Szablon  [1] Realizacja recepty

ID 2.16.840.1.113883.3.4424.13.10.1.27 Data obowiązywania obowiązuje od 2019‑09‑30
Status active Active Etykieta wersji 1.3.1.2
Nazwa plCdaDrugDispense Nazwa wyświetlana [1] Realizacja recepty
Opis Szablon CDA dokumentu realizacji recepty
Kontekst Nazwa ścieżki /
Typ CDA Document Level Template
Otwarty/Zamknięty Otwarty (pozostałe elementy poza zdefiniowanymi są dozwolone)
Używane przez / Używa
Używane przez Szablony 1 transakcji i 0, Używa 8 szablonów
Używane przez jako Nazwa Wersja
plcda-transaction-50 Transakcja final Realizacja recepty 2017‑04‑26
Używa jako Nazwa Wersja
2.16.840.1.113883.3.4424.13.10.2.88 Zawierać active [2] Dane pacjenta dla dokumentu realizacji recepty (1.3.1) DYNAMICZNE
2.16.840.1.113883.3.4424.13.10.2.84 Zawierać active [2] Autor dokumentu realizacji recepty (1.3.1.2) DYNAMICZNE
2.16.840.1.113883.3.4424.13.10.2.20 Zawierać active [2] Organizacja odpowiedzialna za dokument dla P1 (1.3) DYNAMICZNE
2.16.840.1.113883.3.4424.13.10.2.61 Zawierać active [2] Odbiorca informacji (bazowy) (1.3.1) DYNAMICZNE
2.16.840.1.113883.3.4424.13.10.2.6 Zawierać active [2] Wystawca dokumentu (bazowy) (1.3) DYNAMICZNE
2.16.840.1.113883.3.4424.13.10.2.53 Zawierać active [2] Dane zlecenia (bazowy) (1.3) DYNAMICZNE
2.16.840.1.113883.3.4424.13.10.2.83 Zawierać active [2] Dokument powiązany dla dokumentu recepty (1.3) DYNAMICZNE
2.16.840.1.113883.3.4424.13.10.2.80 Zawierać active [2] Treść dokumentu realizacji recepty (1.3.1.1) DYNAMICZNE
Relacje Specialization: szablon 1.3.6.1.4.1.19376.1.9.1.1.3 (2016‑01‑08 11:13:04)
Przykład
Przykład
<ClinicalDocument xsi:type="extPL:ClinicalDocument">
  <!-- Realizacja recepty farmaceutycznej -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.9.1.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>  <templateId root="2.16.840.1.113883.3.4424.13.10.1.27" extension="1.3.1"/>  <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>  <code code="60593-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication dispensed extended">
    <translation code="04.12" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Realizacja recepty elektronicznej">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>        <value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>        <value code="F" displayName="Farmaceutyczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>        <value code="Z" displayName="zamykająca" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>        <value code="E" displayName="elektroniczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wydania leku"/>        <value code="Z" displayName="zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty elektronicznej</title>  <effectiveTime value="20150301122300"/>  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>  <languageCode code="pl-PL"/>  <setId extension="654321" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>  <versionNumber value="2"/>  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.88"/>    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>      <addr>
        <country>Polska</country>        <postalCode>58-200</postalCode>        <city>Dzierżoniów</city>        <streetName>Szpitalna</streetName>        <houseNumber>3a</houseNumber>        <unitID>10</unitID>      </addr>
      <patient>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>        <name>
          <given>Anna</given>          <given>Maria</given>          <family>Nowak</family>        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>        <birthTime value="19960130"/>      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.84"/>    <functionCode code="FARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Farmaceuta"/>    <time value="20150301122300"/>    <assignedAuthor>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="true"/>      <assignedPerson>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>        <name>
          <prefix>mgr</prefix>          <given>Miłosz</given>          <family>Najman</family>        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>        <name>Apteka porcelanowa</name>        <telecom use="PUB" value="tel:32123456"/>        <addr>
          <country>Polska</country>          <postalCode>31-867</postalCode>          <city>Kraków</city>          <streetName>Mikołaja Kopernika</streetName>          <houseNumber>36</houseNumber>        </addr>
      </representedOrganization>
    </assignedAuthor>
  </author>
  <custodian>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>    <assignedCustodian>
      <representedCustodianOrganization>
        <id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <legalAuthenticator>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>    <time value="20150301122300"/>    <signatureCode code="S"/>    <assignedEntity>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="false"/>    </assignedEntity>
  </legalAuthenticator>
  <relatedDocument typeCode="RPLC">
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.83"/>    <parentDocument classCode="DOCCLIN" moodCode="EVN">
      <id extension="3434344" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>      <code code="60593-1" codeSystem="2.16.840.1.113883.6.1"/>      <setId extension="654321" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>      <versionNumber value="1"/>    </parentDocument>
  </relatedDocument>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.80"/>    <structuredBody>
      <component>
        <section>
          <templateId root="1.3.6.1.4.1.19376.1.9.1.2.3"/>          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>          <id extension="4334343" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>          <title>Wydanie leku</title>          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydano lek gotowy</caption>               Nazwa: Enarenal              <br/>               Postać:
tabletki
              <br/>               Dawka: 5mg              <br/>               Opakowanie: 60 tabl.              <br/>               Ilość:
1
              <br/>               Nr serii: 123/456              <br/>               Data ważności: 1 stycznia 2018
r.
              <br/>               Identyfikator produktu: 5909990014958 (GS1/EAN)             </paragraph>
            <paragraph ID="ACT_1">
              <caption>Taksacja:</caption>               Wartość wydanego leku: 12,00              <br/>              
Limit urzędowy: 8,40
              <br/>               Poziom odpłatności leku refundowanego:
100%
              <br/>               Kwota refundacji: 0,00               <br/>               Zapłacono: 12,00
            </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>              <templateId root="2.16.840.1.113883.10.20.1.34"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>              <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>              <text>
                <reference value="#SPLY_1"/>              </text>
              <effectiveTime value="20150228"/>              <quantity value="1"/>              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>                    <code code="4321" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Enarenal 5mg tabl."/>                    <name>Enarenal 5mg tabletki</name>                    <lotNumberText>123/456</lotNumberText>                    <pharm:expirationTime value="20180101"/>                    <pharm:asContent classCode="CONT">
                      <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                        <pharm:code code="5909990014958" codeSystem="1.3.160" codeSystemName="GS1"/>                        <pharm:name>Enarenal 5mg (60 tabl.)</pharm:name>                        <pharm:formCode code="30066000" codeSystem="0.4.0.127.0.16.1.1.2.1" codeSystemName="EDQM" displayName="Tablet container"/>                        <pharm:capacityQuantity value="60"/>                      </pharm:containerPackagedMedicine>
                    </pharm:asContent>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>                  <id extension="334455-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>                    </manufacturedProduct>
                  </consumable>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.77"/>                      <id extension="0700000000123456654321" root="2.16.840.1.113883.3.4424.8.10.1"/>                      <code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document"/>                    </externalDocument>
                  </reference>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>                  <text>
                    <reference value="#ACT_1"/>                  </text>
                  <statusCode code="completed"/>                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="12.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="LIMU" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Limit urzędowy"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="8.40"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>                      <statusCode code="completed"/>                      <value xsi:type="CV" code="100%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="0.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="12.00"/>                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>          <text>
            <paragraph>
              <caption>Powód wydania leku</caption>              Zagrożenie życia             </paragraph>
          </text>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>
Przykład
Przykład
<ClinicalDocument xsi:type="extPL:ClinicalDocument">
  <!-- Realizacja recepty na import docelowy -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.9.1.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>  <templateId root="2.16.840.1.113883.3.4424.13.10.1.27" extension="1.3.1"/>  <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>  <code code="60593-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication dispensed extended">
    <translation code="04.13" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Realizacja recepty papierowej">
      <qualifier>
        <name code="KDLEK" codeSystem="2. 16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>        <value code="Lz" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>        <value code="I" displayName="Import docelowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>        <value code="Z" displayName="zamykająca" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>        <value code="P" displayName="papierowa" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="RRECP" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj recepty papierowej"/>        <value code="ZW" displayName="zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wydania leku"/>        <value code="Z" displayName="zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty papierowej</title>  <effectiveTime value="20150301122300"/>  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>  <languageCode code="pl-PL"/>  <setId extension="24543234" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>  <versionNumber value="1"/>  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.88"/>    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>      <addr>
        <country>Polska</country>        <postalCode>58-200</postalCode>        <city>Dzierżoniów</city>        <streetName>Szpitalna</streetName>        <houseNumber>3a</houseNumber>        <unitID>10</unitID>      </addr>
      <patient>
        <name>
          <given>Anna</given>          <given>Maria</given>          <family>Nowak</family>        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>        <birthTime value="19960130"/>      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.84"/>    <functionCode code="FARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Farmaceuta"/>    <time value="20150301122300"/>    <assignedAuthor>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="true"/>      <assignedPerson>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>        <name>
          <prefix>mgr</prefix>          <given>Miłosz</given>          <family>Najman</family>        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>        <name>Apteka porcelanowa</name>        <telecom use="PUB" value="tel:32123456"/>        <addr>
          <country>Polska</country>          <postalCode>31-867</postalCode>          <city>Kraków</city>          <streetName>Mikołaja Kopernika</streetName>          <houseNumber>36</houseNumber>        </addr>
      </representedOrganization>
    </assignedAuthor>
  </author>
  <custodian>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>    <assignedCustodian>
      <representedCustodianOrganization>
        <id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <legalAuthenticator>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>    <time value="20150301122300"/>    <signatureCode code="S"/>    <assignedEntity>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="false"/>    </assignedEntity>
  </legalAuthenticator>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.80"/>    <structuredBody>
      <component>
        <section>
          <templateId root="1.3.6.1.4.1.19376.1.9.1.2.3"/>          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>          <id extension="543212345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>          <title>Taksacja</title>          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydano lek gotowy</caption>               Nazwa: Morphini Sulfas WZF
0,1% Spinal
              <br/>               Postać: roztwór do wstrzykiwań              <br/>               Moc: 0,1%              <br/>              
Opakowanie: 10 amp. po 2 ml
              <br/>               Ilość: 1              <br/>               Nr serii:
123/456
              <br/>               Data ważności: 1 stycznia 2018 r.              <br/>               Identyfikator
produktu: 5909990014958 (GS1/EAN)
            </paragraph>
            <paragraph ID="ACT_1">
               Wartość wydanego leku: 50,00              <br/>               Poziom
odpłatności leku refundowanego: 100%
              <br/>               Kwota refundacji: 0,00
              <br/>               Zapłacono: 50,60             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>              <templateId root="2.16.840.1.113883.10.20.1.34"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>              <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>              <text>
                <reference value="#SPLY_1"/>              </text>
              <quantity value="1"/>              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>                    <code code="232121" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Morphini Sulfas WZF 0,1% Spinal roztwór do wstrzykiwań"/>                    <name>Morphini Sulfas WZF 0,1% Spinal</name>                    <pharm:formCode code="11201000" codeSystem="0.4.0.127.0.16.1.1.2.1" codeSystemName="EDQM" displayName="Solution for injection"/>                    <lotNumberText>123/456</lotNumberText>                    <pharm:expirationTime value="20180101"/>                    <pharm:asContent classCode="CONT">
                      <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                        <pharm:code code="5909991040123" codeSystem="1.3.160" codeSystemName="GS1"/>                        <pharm:name>Morphini Sulfas WZF 0,1% Spinal (10 amp.
2ml)
</pharm:name>
                        <pharm:formCode code="30001000" codeSystem="0.4.0.127.0.16.1.1.2.1" codeSystemName="EDQM" displayName="Ampoule"/>                        <pharm:capacityQuantity value="2" unit="ml"/>                        <pharm:asSuperContent classCode="CONT">
                          <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                            <pharm:capacityQuantity value="10"/>                          </pharm:containerPackagedMedicine>
                        </pharm:asSuperContent>
                      </pharm:containerPackagedMedicine>
                    </pharm:asContent>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>                  <id extension="0700000000123456754321-1" root="2.16.840.1.113883.3.4424.8.10.1"/>                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>                    </manufacturedProduct>
                  </consumable>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.77"/>                      <id extension="0700000000123456754321" root="2.16.840.1.113883.3.4424.8.10.2"/>                      <code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document"/>                    </externalDocument>
                  </reference>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>                  <text>
                    <reference value="#ACT_1"/>                  </text>
                  <statusCode code="completed"/>                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="50.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>                      <statusCode code="completed"/>                      <value xsi:type="CV" code="100%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="0.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="50.00"/>                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
              <reference typeCode="REFR">
                <externalDocument>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.72"/>                  <id extension="12342/2017" root="2.16.840.1.113883.3.4424.8.11"/>                </externalDocument>
              </reference>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>          <title>Dane o ubezpieczeniu i uprawnieniach</title>          <text>
            <paragraph ID="ACT_2">
               Oddział NFZ: 07               <br/>               Uprawnienia dodatkowe: ZK
(Nr leg.: 238/2015)
            </paragraph>
          </text>
          <entry>
            <act classCode="ACT" moodCode="DEF">
              <templateId root="2.16.840.1.113883.10.20.1.20"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>              <id nullFlavor="NA"/>              <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>              <text>
                <reference value="#ACT_2"/>              </text>
              <statusCode code="completed"/>              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <!-- Uprawnienie dodatkowe -->
                  <templateId root="2.16.840.1.113883.10.20.1.26"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>                  <id nullFlavor="NA"/>                  <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>                      <value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>                    </qualifier>
                  </code>
                  <statusCode code="completed"/>                  <performer typeCode="PRF">
                    <!-- Dane ubezpieczyciela/płatnika -->
                    <assignedEntity>
                      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>                    </assignedEntity>
                  </performer>
                  <entryRelationship typeCode="REFR">
                    <act classCode="ACT" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.10.20.1.19"/>                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>                      <id nullFlavor="NA"/>                      <code nullFlavor="NA"/>                      <entryRelationship typeCode="SUBJ">
                        <supply classCode="SPLY" moodCode="PRMS">
                          <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>                        </supply>
                      </entryRelationship>
                    </act>
                  </entryRelationship>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>                      <text>Nr leg.: 238/2015</text>                    </externalDocument>
                  </reference>
                </act>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>
Przykład
Przykład
<ClinicalDocument xsi:type="extPL:ClinicalDocument">
  <!-- Realizacja recepty na lek recepturowy -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.9.1.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>  <templateId root="2.16.840.1.113883.3.4424.13.10.1.27" extension="1.3.1"/>  <id extension="5432345" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>  <code code="60593-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication dispensed extended">
    <translation code="04.12" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Realizacja recepty elektronicznej">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>        <value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>        <value code="R" displayName="Lek recepturowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>        <value code="Z" displayName="zamykająca" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>        <value code="E" displayName="elektroniczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wydania leku"/>        <value code="Z" displayName="zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty elektronicznej</title>  <effectiveTime value="20150301122300"/>  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>  <languageCode code="pl-PL"/>  <setId extension="8765456765" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>  <versionNumber value="1"/>  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.88"/>    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>      <addr>
        <country>Polska</country>        <postalCode>58-200</postalCode>        <city>Dzierżoniów</city>        <streetName>Szpitalna</streetName>        <houseNumber>3a</houseNumber>        <unitID>10</unitID>      </addr>
      <patient>
        <name>
          <given>Anna</given>          <given>Maria</given>          <family>Nowak</family>        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>        <birthTime value="19960130"/>      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.84"/>    <functionCode code="FARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Farmaceuta"/>    <time value="20150301122300"/>    <assignedAuthor>
      <id extension="712178" root="2.16.840.1.13883.3.4424.1.6.1" displayable="true"/>      <assignedPerson>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>        <name>
          <prefix>mgr</prefix>          <given>Miłosz</given>          <family>Najman</family>        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>        <name>Apteka porcelanowa</name>        <telecom use="PUB" value="tel:32123456"/>        <addr>
          <country>Polska</country>          <postalCode>31-867</postalCode>          <city>Kraków</city>          <streetName>Mikołaja Kopernika</streetName>          <houseNumber>36</houseNumber>        </addr>
      </representedOrganization>
    </assignedAuthor>
  </author>
  <custodian>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>    <assignedCustodian>
      <representedCustodianOrganization>
        <id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <legalAuthenticator>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>    <time value="20150301122300"/>    <signatureCode code="S"/>    <assignedEntity>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="false"/>    </assignedEntity>
  </legalAuthenticator>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.80"/>    <structuredBody>
      <component>
        <section>
          <templateId root="1.3.6.1.4.1.19376.1.9.1.2.3"/>          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>          <id extension="234565432345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>          <title>Wydanie leku</title>          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydanie leku recepturowego</caption>               Receptura:              <br/>              
Lanolini 25,0
              <br/>               Vaselini albi 25,0              <br/>               Paraffini liq. 10,0              <br/>              
Aquae aa ad 100,0
              <br/>               Postać: maść              <br/>               Ilość: 100 g              <br/>            </paragraph>
            <paragraph ID="ACT_1">
              <caption>Taksacja:</caption>               Wartość wydanego leku: 30,00              <br/>              
Poziom odpłatności leku refundowanego: 30%
              <br/>               Kwota refundacji:
21,00
              <br/>               Zapłacono: 9,00              <br/>               Taksa laborum: 12,33             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>              <templateId root="2.16.840.1.113883.10.20.1.34"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>              <id extension="3243432" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>              <text>
                <reference value="#SPLY_1"/>              </text>
              <quantity value="100" unit="g"/>              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.70"/>                    <code nullFlavor="NA"/>                    <name>Maść pośladkowa</name>                    <pharm:formCode code="10504000" codeSystem="0.4.0.127.0.16.1.1.2.1" codeSystemName="EDQM" displayName="Ointment"/>                    <pharm:ingredient classCode="ACTI">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>                      <pharm:quantity>
                        <numerator xsi:type="PQ" value="25" unit="g"/>                        <denominator xsi:type="PQ" value="1"/>                      </pharm:quantity>
                      <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                        <pharm:code code="23432" codeSystem="2.16.840.1.113883.3.4424.6.3" displayName="Wazelina biała"/>                        <pharm:name>Vaselinum album</pharm:name>                      </pharm:ingredient>
                    </pharm:ingredient>
                    <pharm:ingredient classCode="ACTI">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>                      <pharm:quantity>
                        <numerator xsi:type="PQ" value="25" unit="g"/>                        <denominator xsi:type="PQ" value="1"/>                      </pharm:quantity>
                      <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                        <pharm:code code="34543" codeSystem="2.16.840.1.113883.3.4424.6.3" displayName="Lanolina"/>                        <pharm:name>Lanolinum</pharm:name>                      </pharm:ingredient>
                    </pharm:ingredient>
                    <pharm:ingredient classCode="ACTI">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>                      <pharm:quantity>
                        <numerator xsi:type="PQ" value="10" unit="g"/>                        <denominator xsi:type="PQ" value="1"/>                      </pharm:quantity>
                      <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                        <pharm:code code="45654" codeSystem="2.16.840.1.113883.3.4424.6.3" displayName="Parafina ciekła"/>                        <pharm:name>Paraffinum liquidum</pharm:name>                      </pharm:ingredient>
                    </pharm:ingredient>
                    <pharm:ingredient classCode="ACTI">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>                      <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                        <pharm:code code="56765" codeSystem="2.16.840.1.113883.3.4424.6.3" displayName="Woda do receptury aptecznej FP"/>                        <pharm:name>Aqua</pharm:name>                      </pharm:ingredient>
                    </pharm:ingredient>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>                  <id extension="656789-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>                    </manufacturedProduct>
                  </consumable>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.77"/>                      <id extension="0700000000123456712345" root="2.16.840.1.113883.3.4424.8.10.1"/>                      <code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document"/>                    </externalDocument>
                  </reference>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>                  <text>
                    <reference value="#ACT_1"/>                  </text>
                  <statusCode code="completed"/>                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="30.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>                      <statusCode code="completed"/>                      <value xsi:type="CV" code="30%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="21.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="9.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="TAKL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksa laborum"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="12.33"/>                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>          <title>Dane o ubezpieczeniu i uprawnieniach</title>          <text>
            <paragraph ID="ACT_2">
               Oddział NFZ: 07               <br/>               Uprawnienia dodatkowe: ZK
(Nr leg.: 238/2015)
            </paragraph>
          </text>
          <entry>
            <act classCode="ACT" moodCode="DEF">
              <templateId root="2.16.840.1.113883.10.20.1.20"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>              <id nullFlavor="NA"/>              <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>              <text>
                <reference value="#ACT_2"/>              </text>
              <statusCode code="completed"/>              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <!-- Uprawnienie dodatkowe -->
                  <templateId root="2.16.840.1.113883.10.20.1.26"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>                  <id nullFlavor="NA"/>                  <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>                      <value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>                    </qualifier>
                  </code>
                  <statusCode code="completed"/>                  <performer typeCode="PRF">
                    <!-- Dane ubezpieczyciela/płatnika -->
                    <assignedEntity>
                      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>                    </assignedEntity>
                  </performer>
                  <entryRelationship typeCode="REFR">
                    <act classCode="ACT" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.10.20.1.19"/>                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>                      <id nullFlavor="NA"/>                      <code nullFlavor="NA"/>                      <entryRelationship typeCode="SUBJ">
                        <supply classCode="SPLY" moodCode="PRMS">
                          <id extension="3243432" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>                        </supply>
                      </entryRelationship>
                    </act>
                  </entryRelationship>
                  <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>                      <text>Nr leg.: 238/2015</text>                    </externalDocument>
                  </reference>
                </act>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>
Przykład
Przykład
<ClinicalDocument xsi:type="extPL:ClinicalDocument">
  <!-- Realizacja recepty spełniającej wymagania związane z refundacją -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.9.1.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>  <templateId root="2.16.840.1.113883.3.4424.13.10.1.27" extension="1.3.1"/>  <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>  <code code="60593-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication dispensed extended">
    <translation code="04.12" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Realizacja recepty elektronicznej">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>        <value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>        <value code="C" displayName="częściowa" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>        <value code="E" displayName="elektroniczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wydania leku"/>        <value code="Z" displayName="zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty elektronicznej</title>  <effectiveTime value="20150301122300"/>  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>  <languageCode code="pl-PL"/>  <setId extension="24543234" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>  <versionNumber value="1"/>  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.88"/>    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>      <addr>
        <country>Polska</country>        <postalCode>58-200</postalCode>        <city>Dzierżoniów</city>        <streetName>Szpitalna</streetName>        <houseNumber>3a</houseNumber>        <unitID>10</unitID>      </addr>
      <patient>
        <name>
          <given>Anna</given>          <given>Maria</given>          <family>Nowak</family>        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>        <birthTime value="19960130"/>      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.84"/>    <functionCode code="TFARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Technik farmaceutyczny"/>    <time value="20150301122300"/>    <assignedAuthor xsi:type="extPL:AssignedAuthor">
      <id extension="83120199999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>      <assignedPerson>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>        <name>
          <prefix>tech. farm.</prefix>          <given>Jerzy</given>          <family>Miarka</family>        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>        <name>Apteka porcelanowa</name>        <telecom use="PUB" value="tel:32123456"/>        <addr>
          <country>Polska</country>          <postalCode>31-867</postalCode>          <city>Kraków</city>          <streetName>Mikołaja Kopernika</streetName>          <houseNumber>36</houseNumber>        </addr>
      </representedOrganization>
      <extPL:boundedBy typeCode="PART">
        <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.44"/>        <extPL:reimbursementRelatedContract moodCode="EVN" classCode="CNTRCT">
          <extPL:id extension="123456" root="2.16.840.1.113883.3.4424.8.6.3.7"/>          <extPL:bounding typeCode="PART">
            <extPL:reimburser classCode="UNDWRT">
              <extPL:id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>            </extPL:reimburser>
          </extPL:bounding>
        </extPL:reimbursementRelatedContract>
      </extPL:boundedBy>
    </assignedAuthor>
  </author>
  <custodian>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>    <assignedCustodian>
      <representedCustodianOrganization>
        <id extension="83120199999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="false"/>      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <legalAuthenticator>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>    <time value="20150301122300"/>    <signatureCode code="S"/>    <assignedEntity>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="false"/>    </assignedEntity>
  </legalAuthenticator>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.80"/>    <structuredBody>
      <component>
        <section>
          <templateId root="1.3.6.1.4.1.19376.1.9.1.2.3"/>          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>          <id extension="543212345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>          <title>Wydanie leku</title>          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydano lek gotowy</caption>               Nazwa: Enarenal              <br/>               Postać:
tabletki
              <br/>               Dawka: 5mg              <br/>               Opakowanie: 60 tabl.              <br/>               Ilość:
1
              <br/>               Nr serii: 123/890              <br/>               Data ważności: 1 stycznia 2018
r.
              <br/>               Identyfikator produktu: 5909990014958 (GS1/EAN)             </paragraph>
            <paragraph ID="ACT_1">
              <caption>Taksacja</caption>               Wartość wydanego leku: 12,00              <br/>               Limit
urzędowy: 8,40
              <br/>               Poziom odpłatności leku refundowanego: 30%              <br/>              
Kwota refundacji: 8,40
              <br/>               Zapłacono: 3,60             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>              <templateId root="2.16.840.1.113883.10.20.1.34"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>              <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>              <text>
                <reference value="#SPLY_1"/>              </text>
              <quantity value="1"/>              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>                    <code code="4321" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Enarenal 5mg tabl."/>                    <name>Enarenal 5mg tabletki</name>                    <lotNumberText>123/890</lotNumberText>                    <pharm:expirationTime value="20180101"/>                    <pharm:asContent classCode="CONT">
                      <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                        <pharm:code code="5909990014958" codeSystem="1.3.160" codeSystemName="GS1"/>                        <pharm:name>Enarenal 5mg (60 tabl.)</pharm:name>                        <pharm:formCode code="30066000" codeSystem="0.4.0.127.0.16.1.1.2.1" codeSystemName="EDQM" displayName="Tablet container"/>                        <pharm:capacityQuantity value="60"/>                      </pharm:containerPackagedMedicine>
                    </pharm:asContent>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>                  <id extension="2343aab-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>                    </manufacturedProduct>
                  </consumable>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.77"/>                      <id extension="0700000000123456789213" root="2.16.840.1.113883.3.4424.8.10.1"/>                      <code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document"/>                    </externalDocument>
                  </reference>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>                  <text>
                    <reference value="#ACT_1"/>                  </text>
                  <statusCode code="completed"/>                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="12.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="LIMU" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Limit urzędowy"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="8.40"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>                      <statusCode code="completed"/>                      <value xsi:type="CV" code="30%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="8.40"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="3.60"/>                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>          <title>Dane o ubezpieczeniu i uprawnieniach</title>          <text>
            <paragraph ID="ACT_2">
               Oddział NFZ: 07               <br/>               Uprawnienia dodatkowe: ZK
(Nr leg.: 238/2015)
            </paragraph>
          </text>
          <entry>
            <act classCode="ACT" moodCode="DEF">
              <templateId root="2.16.840.1.113883.10.20.1.20"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>              <id nullFlavor="NA"/>              <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>              <text>
                <reference value="#ACT_2"/>              </text>
              <statusCode code="completed"/>              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <!-- Uprawnienie dodatkowe -->
                  <templateId root="2.16.840.1.113883.10.20.1.26"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>                  <id nullFlavor="NA"/>                  <id nullFlavor="NA"/>                  <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>                      <value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>                    </qualifier>
                  </code>
                  <statusCode code="completed"/>                  <performer typeCode="PRF">
                    <!-- Dane ubezpieczyciela/płatnika -->
                    <assignedEntity>
                      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>                    </assignedEntity>
                  </performer>
                  <entryRelationship typeCode="REFR">
                    <act classCode="ACT" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.10.20.1.19"/>                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>                      <id nullFlavor="NA"/>                      <code nullFlavor="NA"/>                      <entryRelationship typeCode="SUBJ">
                        <supply classCode="SPLY" moodCode="PRMS">
                          <id extension="543212345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>                        </supply>
                      </entryRelationship>
                    </act>
                  </entryRelationship>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>                      <text>Nr leg.: 238/2015</text>                    </externalDocument>
                  </reference>
                </act>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>          <text>
            <paragraph>
              <caption>Adnotacja farmaceuty</caption>              Wydano zamiennik
            </paragraph>
          </text>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>
Przykład
Przykład
<ClinicalDocument xsi:type="extPL:ClinicalDocument">
  <!-- Realizacja wycofujaca recepty -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.9.1.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>  <templateId root="2.16.840.1.113883.3.4424.13.10.1.27" extension="1.3.1"/>  <id extension="bc34221ax" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>  <code code="60593-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication dispensed extended">
    <translation code="04.12" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Realizacja recepty elektronicznej">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>        <value code="Rpw" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>        <value code="W" displayName="wycofująca" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>        <value code="E" displayName="elektroniczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wydania leku"/>        <value code="Z" displayName="zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty elektronicznej</title>  <effectiveTime value="20150301122300"/>  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>  <languageCode code="pl-PL"/>  <setId extension="432321" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>  <versionNumber value="2"/>  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.88"/>    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>      <addr>
        <country>Polska</country>        <postalCode>58-200</postalCode>        <city>Dzierżoniów</city>        <streetName>Szpitalna</streetName>        <houseNumber>3a</houseNumber>        <unitID>10</unitID>      </addr>
      <patient>
        <name>
          <given>Anna</given>          <given>Maria</given>          <family>Nowak</family>        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>        <birthTime value="19960130"/>      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.84"/>    <functionCode code="FARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Farmaceuta"/>    <time value="20150301122300"/>    <assignedAuthor>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="true"/>      <assignedPerson>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>        <name>
          <prefix>mgr</prefix>          <given>Miłosz</given>          <family>Najman</family>        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>        <name>Apteka porcelanowa</name>        <telecom use="PUB" value="tel:32123456"/>        <addr>
          <country>Polska</country>          <postalCode>31-867</postalCode>          <city>Kraków</city>          <streetName>Mikołaja Kopernika</streetName>          <houseNumber>36</houseNumber>        </addr>
      </representedOrganization>
    </assignedAuthor>
  </author>
  <custodian>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>    <assignedCustodian>
      <representedCustodianOrganization>
        <id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <legalAuthenticator>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>    <time value="20150301122300"/>    <signatureCode code="S"/>    <assignedEntity>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="false"/>    </assignedEntity>
  </legalAuthenticator>
  <relatedDocument typeCode="RPLC">
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.83"/>    <parentDocument classCode="DOCCLIN" moodCode="EVN">
      <id extension="232123" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>      <code code="60593-1" codeSystem="2.16.840.1.113883.6.1"/>      <setId extension="432321" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>      <versionNumber value="1"/>    </parentDocument>
  </relatedDocument>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.80"/>    <structuredBody>
      <component>
        <section>
          <templateId root="1.3.6.1.4.1.19376.1.9.1.2.3"/>          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>          <id extension="12345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>          <title>Wydanie leku</title>          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydano lek gotowy</caption>               Nazwa: MST Continus              <br/>              
Postać: tabletki
              <br/>               Dawka: 100mg              <br/>               Opakowanie: 30 tabl.              <br/>              
Ilość: 1
              <br/>               Identyfikator produktu: 5909990476527 (GS1/EAN)             </paragraph>
            <paragraph ID="ACT_1">
              <caption>Taksacja:</caption>              s Wartość wydanego leku: 0,00              <br/>              
Limit urzędowy: 7,01
              <br/>               Poziom odpłatności leku refundowanego:
R
              <br/>               Kwota refundacji: 7,01               <br/>               Zapłacono: 0,00             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>              <templateId root="2.16.840.1.113883.10.20.1.34"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>              <id extension="bc34221ax" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>              <text>
                <reference value="#SPLY_1"/>              </text>
              <effectiveTime value="20150212"/>              <quantity value="0"/>              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>                    <code code="4321" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="MST Continus 100mg tabl. powl. o zmod. uwalnianiu"/>                    <name>MST Continus 100mg tabletki</name>                    <pharm:asContent classCode="CONT">
                      <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                        <pharm:code code="5909990476527" codeSystem="1.3.160" codeSystemName="GS1"/>                        <pharm:name>MST Continus 100mg tabl. powl. o zmod.
uwalnianiu (30 tabl.)
</pharm:name>
                        <pharm:formCode code="30066000" codeSystem="0.4.0.127.0.16.1.1.2.1" codeSystemName="EDQM" displayName="Tablet container"/>                        <pharm:capacityQuantity value="30"/>                      </pharm:containerPackagedMedicine>
                    </pharm:asContent>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>                  <id extension="ff3432b-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>                    </manufacturedProduct>
                  </consumable>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.77"/>                      <id extension="0700000000123456789009" root="2.16.840.1.113883.3.4424.8.10.1"/>                      <code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document"/>                    </externalDocument>
                  </reference>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>                  <text>
                    <reference value="#ACT_1"/>                  </text>
                  <statusCode code="completed"/>                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="0.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="LIMU" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Limit urzędowy"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="7.01"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>                      <statusCode code="completed"/>                      <value xsi:type="CV" code="R" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="7.01"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="0.00"/>                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>          <title>Dane o ubezpieczeniu i uprawnieniach</title>          <text>
            <paragraph ID="ACT_2">
               Oddział NFZ: 07               <br/>               Uprawnienia dodatkowe: ZK
(Nr leg.: 238/2015)
            </paragraph>
          </text>
          <entry>
            <act classCode="ACT" moodCode="DEF">
              <templateId root="2.16.840.1.113883.10.20.1.20"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>              <id nullFlavor="NA"/>              <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>              <text>
                <reference value="#ACT_2"/>              </text>
              <statusCode code="completed"/>              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <!-- Uprawnienie dodatkowe -->
                  <templateId root="2.16.840.1.113883.10.20.1.26"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>                  <id nullFlavor="NA"/>                  <id nullFlavor="NA"/>                  <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>                      <value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>                    </qualifier>
                  </code>
                  <statusCode code="completed"/>                  <performer typeCode="PRF">
                    <!-- Dane ubezpieczyciela/płatnika -->
                    <assignedEntity>
                      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>                    </assignedEntity>
                  </performer>
                  <entryRelationship typeCode="REFR">
                    <act classCode="ACT" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.10.20.1.19"/>                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>                      <id nullFlavor="NA"/>                      <code nullFlavor="NA"/>                      <entryRelationship typeCode="SUBJ">
                        <supply classCode="SPLY" moodCode="PRMS">
                          <id extension="bc34221ax" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>                        </supply>
                      </entryRelationship>
                    </act>
                  </entryRelationship>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>                      <text>Nr leg.: 238/2015</text>                    </externalDocument>
                  </reference>
                </act>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>
Przykład
Przykład
<ClinicalDocument xsi:type="extPL:ClinicalDocument">
  <!-- Realizacja recepty spełniającej wymagania związane z refundacją - wydanie zamiennika leku -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.9.1.1.3"/>  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>  <templateId root="2.16.840.1.113883.3.4424.13.10.1.27" extension="1.3.1"/>  <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>  <code code="60593-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication dispensed extended">
    <translation code="04.13" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Realizacja recepty papierowej">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>        <value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>        <value code="C" displayName="częściowa" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>        <value code="P" displayName="papierowa" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="RRECP" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj recepty papierowej"/>        <value code="PF" displayName="pro familia" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
      <qualifier>
        <name code="TWLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wydania leku"/>        <value code="Z" displayName="zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty papierowej</title>  <effectiveTime value="20150301122300"/>  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>  <languageCode code="pl-PL"/>  <setId extension="24543234" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>  <versionNumber value="1"/>  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.88"/>    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>      <addr>
        <country>Polska</country>        <postalCode>58-200</postalCode>        <city>Dzierżoniów</city>        <streetName>Szpitalna</streetName>        <houseNumber>3a</houseNumber>        <unitID>10</unitID>      </addr>
      <patient>
        <name>
          <given>Anna</given>          <given>Maria</given>          <family>Nowak</family>        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>        <birthTime value="19960130"/>      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.84"/>    <functionCode code="TFARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Technik farmaceutyczny"/>    <time value="20150301122300"/>    <assignedAuthor xsi:type="extPL:AssignedAuthor">
      <id extension="83120199999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>      <assignedPerson>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>        <name>
          <prefix>tech. farm.</prefix>          <given>Jerzy</given>          <family>Miarka</family>        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>        <name>Apteka porcelanowa</name>        <telecom use="PUB" value="tel:32123456"/>        <addr>
          <country>Polska</country>          <postalCode>31-867</postalCode>          <city>Kraków</city>          <streetName>Mikołaja Kopernika</streetName>          <houseNumber>36</houseNumber>        </addr>
      </representedOrganization>
      <extPL:boundedBy typeCode="PART">
        <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.44"/>        <extPL:reimbursementRelatedContract moodCode="EVN" classCode="CNTRCT">
          <extPL:id extension="123456" root="2.16.840.1.113883.3.4424.8.6.3.7"/>          <extPL:bounding typeCode="PART">
            <extPL:reimburser classCode="UNDWRT">
              <extPL:id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>            </extPL:reimburser>
          </extPL:bounding>
        </extPL:reimbursementRelatedContract>
      </extPL:boundedBy>
    </assignedAuthor>
  </author>
  <custodian>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>    <assignedCustodian>
      <representedCustodianOrganization>
        <id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <legalAuthenticator>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>    <time value="20150301122300"/>    <signatureCode code="S"/>    <assignedEntity>
      <id extension="83120199999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="false"/>    </assignedEntity>
  </legalAuthenticator>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.80"/>    <structuredBody>
      <component>
        <section>
          <templateId root="1.3.6.1.4.1.19376.1.9.1.2.3"/>          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>          <id extension="543212345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>          <title>Wydanie leku</title>          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydano lek gotowy</caption>               Nazwa: Polpril              <br/>               Postać:
tabletki
              <br/>               Dawka: 5mg              <br/>               Opakowanie: 28 tabl.              <br/>               Ilość:
1
              <br/>               Identyfikator produktu: 5909990924646 (GS1/EAN)              <br/>              <content ID="ACT_1">Wydano zamiennik</content>            </paragraph>
            <paragraph ID="ACT_2">
              <caption>Taksacja</caption>               Wartość wydanego leku: 12,00              <br/>               Limit
urzędowy: 8,40
              <br/>               Poziom odpłatności leku refundowanego: 30%              <br/>              
Kwota refundacji: 8,40
              <br/>               Zapłacono: 3,60             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>              <templateId root="2.16.840.1.113883.10.20.1.34"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>              <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>              <text>
                <reference value="#SPLY_1"/>              </text>
              <quantity value="1"/>              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>                    <code code="4321" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Enarenal 5mg tabl."/>                    <name>Polpril 5mg tabletki</name>                    <pharm:asContent classCode="CONT">
                      <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                        <pharm:code code="5909990924646" codeSystem="1.3.160" codeSystemName="GS1"/>                        <pharm:name>Polpril 5mg (28 tabl.)</pharm:name>                        <pharm:formCode code="30066000" codeSystem="0.4.0.127.0.16.1.1.2.1" codeSystemName="EDQM" displayName="Tablet container"/>                        <pharm:capacityQuantity value="28"/>                      </pharm:containerPackagedMedicine>
                    </pharm:asContent>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>                  <id extension="0700000000123456789012-1" root="2.16.840.1.113883.3.4424.8.10.1"/>                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>                    </manufacturedProduct>
                  </consumable>
                  <author>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.78"/>                    <time value="20150227"/>                    <assignedAuthor>
                      <id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>                      <representedOrganization>
                        <id extension="123456789" root="2.16.840.1.113883.3.4424.2.2.1" displayable="true"/>                      </representedOrganization>
                    </assignedAuthor>
                  </author>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.77"/>                      <id extension="0700000000123456789012" root="2.16.840.1.113883.3.4424.8.10.2"/>                      <code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document"/>                    </externalDocument>
                  </reference>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.79"/>                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.9.2"/>                  <code code="E" codeSystem="2.16.840.1.113883.5.1070" codeSystemName="HL7 Substance Admin Substitution" displayName="equivalent"/>                  <text>
                    <reference value="#ACT_1"/>                  </text>
                  <statusCode code="completed"/>                </act>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>                  <text>
                    <reference value="#ACT_2"/>                  </text>
                  <statusCode code="completed"/>                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="12.00"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="LIMU" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Limit urzędowy"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="8.40"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>                      <statusCode code="completed"/>                      <value xsi:type="CV" code="30%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="8.40"/>                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>                      <statusCode code="completed"/>                      <value xsi:type="REAL" value="3.60"/>                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>          <title>Dane o ubezpieczeniu i uprawnieniach</title>          <text>
            <paragraph ID="ACT_3">
               Oddział NFZ: 07               <br/>               Uprawnienia dodatkowe: ZK
(Nr leg.: 238/2015)
            </paragraph>
          </text>
          <entry>
            <act classCode="ACT" moodCode="DEF">
              <templateId root="2.16.840.1.113883.10.20.1.20"/>              <templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>              <id nullFlavor="NA"/>              <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>              <text>
                <reference value="#ACT_3"/>              </text>
              <statusCode code="completed"/>              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <!-- Uprawnienie dodatkowe -->
                  <templateId root="2.16.840.1.113883.10.20.1.26"/>                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>                  <id nullFlavor="NA"/>                  <id nullFlavor="NA"/>                  <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>                      <value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>                    </qualifier>
                  </code>
                  <statusCode code="completed"/>                  <performer typeCode="PRF">
                    <!-- Dane ubezpieczyciela/płatnika -->
                    <assignedEntity>
                      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>                    </assignedEntity>
                  </performer>
                  <entryRelationship typeCode="REFR">
                    <act classCode="ACT" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.10.20.1.19"/>                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>                      <id nullFlavor="NA"/>                      <code nullFlavor="NA"/>                      <entryRelationship typeCode="SUBJ">
                        <supply classCode="SPLY" moodCode="PRMS">
                          <id extension="543212345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>                        </supply>
                      </entryRelationship>
                    </act>
                  </entryRelationship>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>                      <text>Nr leg.: 238/2015</text>                    </externalDocument>
                  </reference>
                </act>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>          <text>
            <paragraph>
              <caption>Adnotacja farmaceuty</caption>              Wydano zamiennik
            </paragraph>
          </text>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>
Pozycja Typ danych Krotność Wymagalność Opis Etykieta
hl7:ClinicalDocument
1 … 1 M (plCdotsnse)
@classCode
0 … 1 F DOCCLIN
@moodCode
0 … 1 F EVN
hl7:typeId
II 1 … 1 M (plCdotsnse)
@extension
1 … 1 F POCD_HD000040
@root
1 … 1 F 2.16.840.1.113883.1.3
hl7:templateId
II 1 … 1 M (plCdotsnse)
treeblank gdzie [@root='2.16.840.1.113883.3.4424.13.10.1.27']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.13.10.1.27
@extension
st 0 … 1  
hl7:templateId
II 1 … 1 M (plCdotsnse)
treeblank gdzie [@root='1.3.6.1.4.1.19376.1.9.1.1.3']
@root
1 … 1 F 1.3.6.1.4.1.19376.1.9.1.1.3
hl7:templateId
II 1 … 1 R (plCdotsnse)
treeblank gdzie [@root='1.3.6.1.4.1.19376.1.5.3.1.1.1']
@root
1 … 1 F 1.3.6.1.4.1.19376.1.5.3.1.1.1
hl7:id
II 1 … 1 M (plCdotsnse)
@root
uid 1 … 1 R
@extension
st 1 … 1 R
hl7:code
CE 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F 60593-1
@codeSystem
1 … 1 F 2.16.840.1.113883.6.1 (LOINC)
@codeSystemName
1 … 1 F LOINC
@displayName
1 … 1 F Medication dispensed extended
hl7:translation
1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.84 Typ dokumentu realizacji recepty (DYNAMICZNE)
hl7:qualifier
CR 1 … 1 M (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:name/@code='KDLEK']
hl7:name
CV 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F KDLEK
@codeSystem
1 … 1 F 2.16.840.1.113883.3.4424.13.5.1
@codeSystemName
1 … 1 F PolskieKlasyfikatoryHL7v3
@displayName
1 … 1 F Kategoria dostępności leku
hl7:value
CD 1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.75 Kategoria dostępności leku w dokumencie realizacji recepty (DYNAMICZNE)
hl7:qualifier
CR 1 … 1 M (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:name/@code='RLEK']
hl7:name
CV 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F RLEK
@codeSystem
1 … 1 F 2.16.840.1.113883.3.4424.13.5.1
@codeSystemName
1 … 1 F PolskieKlasyfikatoryHL7v3
@displayName
1 … 1 F Rodzaj leku
hl7:value
CD 1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.5 Rodzaj leku (DYNAMICZNE)
hl7:qualifier
CR 1 … 1 M (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:name/@code='TWREC']
hl7:name
CV 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F TWREC
@codeSystem
1 … 1 F 2.16.840.1.113883.3.4424.13.5.1
@codeSystemName
1 … 1 F PolskieKlasyfikatoryHL7v3
@displayName
1 … 1 F Tryb wystawienia recepty
hl7:value
CD 1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.7 Tryb wystawienia recepty (DYNAMICZNE)
hl7:qualifier
CR 1 … 1 M (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:name/@code='TRREC']
hl7:name
CV 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F TRREC
@codeSystem
1 … 1 F 2.16.840.1.113883.3.4424.13.5.1
@codeSystemName
1 … 1 F PolskieKlasyfikatoryHL7v3
@displayName
1 … 1 F Tryb realizacji recepty
hl7:value
CD 1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.8 Tryb realizacji recepty (DYNAMICZNE)
hl7:qualifier
CR 1 … 1 M (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:name/@code='RRREC']
hl7:name
CV 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F RRREC
@codeSystem
1 … 1 F 2.16.840.1.113883.3.4424.13.5.1
@codeSystemName
1 … 1 F PolskieKlasyfikatoryHL7v3
@displayName
1 … 1 F Rodzaj realizacji recepty
hl7:value
CD 1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.76 Rodzaj realizacji recepty (DYNAMICZNE)
hl7:qualifier
CR 1 … 1 M (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:name/@code='PREC']
hl7:name
CV 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F PREC
@codeSystem
1 … 1 F 2.16.840.1.113883.3.4424.13.5.1
@codeSystemName
1 … 1 F PolskieKlasyfikatoryHL7v3
@displayName
1 … 1 F Postać recepty
hl7:value
CD 1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.77 Postać recepty (DYNAMICZNE)
hl7:qualifier
CR 0 … 1 (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:name/@code='RRECP']
hl7:name
CV 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F RRECP
@codeSystem
1 … 1 F 2.16.840.1.113883.3.4424.13.5.1
@codeSystemName
1 … 1 F PolskieKlasyfikatoryHL7v3
@displayName
1 … 1 F Rodzaj recepty papierowej
hl7:value
CD 1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.78 Rodzaj recepty papierowej (DYNAMICZNE)
hl7:qualifier
CR 0 … 1 (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:name/@code='RRECE']
hl7:name
CV 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F RRECE
@codeSystem
1 … 1 F 2.16.840.1.113883.3.4424.13.5.1
@codeSystemName
1 … 1 F PolskieKlasyfikatoryHL7v3
@displayName
1 … 1 F Rodzaj recepty elektronicznej
hl7:value
CD 1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.85 Rodzaj recepty elektronicznej (DYNAMICZNE)
hl7:qualifier
CR 0 … 1 (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:name/@code='TWLEK']
hl7:name
CV 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F TWLEK
@codeSystem
1 … 1 F 2.16.840.1.113883.3.4424.13.5.1
@codeSystemName
1 … 1 F PolskieKlasyfikatoryHL7v3
@displayName
1 … 1 F Tryb wydania leku
hl7:value
CD 1 … 1 M (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.79 Tryb wydania leku (DYNAMICZNE)
hl7:title
ST 1 … 1 M (plCdotsnse)
  Schematron assert rola red error  
  test starts-with(hl7:title,'Realizacja recepty')  
  Komunikat Tytuł dokumentu musi się zaczynać od ciągu znaków: "Realizacja recepty".  
hl7:effectiveTime
TS 1 … 1 M (plCdotsnse)
  Schematron assert rola red error  
  test concat(substring(@value,1,4),'-',substring(@value,5,2),'-',substring(@value,7,2)) castable as xs:date  
  Komunikat Pierwsze 8 cyfr daty powinno być w formacie YYYYMMDD.  
hl7:confidentialityCode
CE 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F N
@codeSystem
1 … 1 F 2.16.840.1.113883.5.25
hl7:languageCode
CS 1 … 1 M (plCdotsnse)
@code
CONF 1 … 1 F pl-PL
hl7:setId
II 1 … 1 M (plCdotsnse)
hl7:versionNumber
INT 1 … 1 M (plCdotsnse)
@value
int 1 … 1 R
Dołączony 1 … 1 M z 2.16.840.1.113883.3.4424.13.10.2.88 [2] Dane pacjenta dla dokumentu realizacji recepty (DYNAMICZNE)
hl7:recordTarget
1 … 1 M (plCdotsnse)
@typeCode
0 … 1 F RCT
@contextControlCode
0 … 1 F OP
hl7:templateId
II 1 … 1 M (plCdotsnse)
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.13.10.2.88
hl7:patientRole
0 … 1 M

notice Ostrzeżenie: Jeśli isMandatory = true, minimumMultiplicity musi być większe od 0.

(plCdotsnse)
@classCode
0 … 1 F PAT
hl7:id
II 1 … * M (plCdotsnse)
@root
uid 1 … 1 R
@extension
st 1 … 1 R
  Schematron report rola red error  
  test @root='2.16.840.1.113883.3.4424.1.1.616' and not(matches(string(@extension),'^[0-9]{11}$'))  
  Komunikat Jeżeli identyfikatorem jest numer PESEL, to musi zawierać 11 cyfr.  
Dołączony 0 … 1 R z 2.16.840.1.113883.3.4424.13.10.7.1 [7] Adres (bazowy) (DYNAMICZNE)
hl7:addr
0 … 1 R (plCdotsnse)
@nullFlavor
cs 0 … 1 F UNK
hl7:country
ADXP 0 … 1 (plCdotsnse)
hl7:postalCode
0 … 1 (plCdotsnse)
@xsi:type
0 … 1 F extPL:adxp
@postCity
st 0 … 1  
hl7:city
ADXP 0 … 1 (plCdotsnse)
hl7:streetName
ADXP 0 … 1 (plCdotsnse)
hl7:houseNumber
ADXP 0 … 1 (plCdotsnse)
hl7:unitID
ADXP 0 … 1 (plCdotsnse)
hl7:unitType
ADXP 0 … 1 (plCdotsnse)
hl7:censusTract
ADXP 0 … 1 (plCdotsnse)
  Schematron report rola red error  
  test not(@nullFlavor) and ((not(hl7:country) or upper-case(hl7:country)='POLSKA') and not(hl7:postalCode))  
  Komunikat Dla polskiego adresu wymagane jest podanie kodu pocztowego.  
  Schematron report rola red error  
  test not(@nullFlavor) and (not(hl7:country) or upper-case(hl7:country)='POLSKA') and not(hl7:city)  
  Komunikat Dla polskiego adresu wymagane jest podanie miasta.  
  Schematron report rola red error  
  test not(@nullFlavor) and (not(hl7:country) or upper-case(hl7:country)='POLSKA') and not(hl7:houseNumber)  
  Komunikat Dla polskiego adresu wymagane jest podanie numeru domu.  
  Schematron assert rola red error  
  test not(hl7:censusTract) or starts-with(hl7:censusTract,'TERYT TERC:') or starts-with(hl7:censusTract,'TERYT SIMC:')  
  Komunikat Poprawnie zapisany numer TERYT powinien zaczynać się od znaków: "TERYT TERC:" lub "TERYT SIMC:".  
  Schematron report rola red error  
  test @nullFlavor and count(./*) > 1  
  Komunikat Jeżeli adres jest nieznany, to nie może zawierać żadnych składników adresu.  
hl7:telecom
TEL 0 … 1 R (plCdotsnse)
hl7:patient
0 … 1 (plCdotsnse)
@classCode
0 … 1 F PSN
@determinerCode
0 … 1 F INSTANCE
hl7:id
II 0 … * NP (plCdotsnse)
Dołączony 0 … 1 R z 2.16.840.1.113883.3.4424.13.10.7.2 [7] Nazwisko i imię osoby (bazowy) (DYNAMICZNE)
hl7:name
0 … 1 R (plCdotsnse)
hl7:prefix
ENXP 0 … 1 (plCdotsnse)
hl7:given
ENXP 1 … * R (plCdotsnse)
hl7:family
ENXP 1 … * R (plCdotsnse)
hl7:administrativeGenderCode
CE 0 … 1 (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.1.11.1 AdministrativeGender (DYNAMICZNE)
hl7:birthTime
TS.DATE 0 … 1 R (plCdotsnse)
  Schematron assert rola red error  
  test concat(substring(@value,1,4),'-',substring(@value,5,2),'-',substring(@value,7,2)) castable as xs:date  
  Komunikat Pierwsze 8 cyfr daty urodzenia powinno być w formacie YYYYMMDD.  
hl7:guardian
0 … * (plCdotsnse)
@classCode
1 … 1 F GUARD
hl7:id
II 1 … * (plCdotsnse)
@root
uid 1 … 1 R
@extension
st 1 … 1 R
  Schematron report rola red error  
  test @root='2.16.840.1.113883.3.4424.1.1.616' and not(matches(string(@extension),'^[0-9]{11}$'))  
  Komunikat Jeżeli identyfikatorem jest numer PESEL to musi zawierać 11 cyfr.  
hl7:code
CE 0 … 1 (plCdotsnse)
@codeSystem
CONF 0 … 1 F 2.16.840.1.113883.5.111
Dołączony 0 … 1 z 2.16.840.1.113883.3.4424.13.10.7.1 [7] Adres (bazowy) (DYNAMICZNE)
hl7:addr
0 … 1 (plCdotsnse)
@nullFlavor
cs 0 … 1 F UNK
hl7:country
ADXP 0 … 1 (plCdotsnse)
hl7:postalCode
0 … 1 (plCdotsnse)
@xsi:type
0 … 1 F extPL:adxp
@postCity
st 0 … 1  
hl7:city
ADXP 0 … 1 (plCdotsnse)
hl7:streetName
ADXP 0 … 1 (plCdotsnse)
hl7:houseNumber
ADXP 0 … 1 (plCdotsnse)
hl7:unitID
ADXP 0 … 1 (plCdotsnse)
hl7:unitType
ADXP 0 … 1 (plCdotsnse)
hl7:censusTract
ADXP 0 … 1 (plCdotsnse)
  Schematron report rola red error  
  test not(@nullFlavor) and ((not(hl7:country) or upper-case(hl7:country)='POLSKA') and not(hl7:postalCode))  
  Komunikat Dla polskiego adresu wymagane jest podanie kodu pocztowego.  
  Schematron report rola red error  
  test not(@nullFlavor) and (not(hl7:country) or upper-case(hl7:country)='POLSKA') and not(hl7:city)  
  Komunikat Dla polskiego adresu wymagane jest podanie miasta.  
  Schematron report rola red error  
  test not(@nullFlavor) and (not(hl7:country) or upper-case(hl7:country)='POLSKA') and not(hl7:houseNumber)  
  Komunikat Dla polskiego adresu wymagane jest podanie numeru domu.  
  Schematron assert rola red error  
  test not(hl7:censusTract) or starts-with(hl7:censusTract,'TERYT TERC:') or starts-with(hl7:censusTract,'TERYT SIMC:')  
  Komunikat Poprawnie zapisany numer TERYT powinien zaczynać się od znaków: "TERYT TERC:" lub "TERYT SIMC:".  
  Schematron report rola red error  
  test @nullFlavor and count(./*) > 1  
  Komunikat Jeżeli adres jest nieznany, to nie może zawierać żadnych składników adresu.  
Wybór 1 … 1 Elementy do wyboru z:
hl7:guardianPerson
Zawiera 2.16.840.1.113883.3.4424.13.10.2.1 [2] Osoba (bazowy) (DYNAMICZNE) (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [hl7:templateId [@root='2.16.840.1.113883.3.4424.13.10.2.1']]
hl7:guardianOrganization
Zawiera 2.16.840.1.113883.3.4424.13.10.2.2 [2] Organizacja (bazowy) (DYNAMICZNE) (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [hl7:templateId [@root='2.16.840.1.113883.3.4424.13.10.2.2']]
extPL:multipleBirthInd
BL 0 … 1 (plCdotsnse)
extPL:multipleBirthOrderNumber
INT.POS 0 … 1 (plCdotsnse)
  Schematron report rola red error  
  test extPL:multipleBirthInd/@value and not(extPL:multipleBirthOrderNumber/@value)  
  Komunikat Dla ciąży mnogiej wymagane jest podanie numeru kolejności urodzenia.  
hl7:providerOrganization
0 … 1 Zawiera 2.16.840.1.113883.3.4424.13.10.2.2 [2] Organizacja (bazowy) (DYNAMICZNE) (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:templateId [@root='2.16.840.1.113883.3.4424.13.10.2.2']]
  Schematron report rola red error  
  test /hl7:ClinicalDocument[hl7:code[hl7:translation[hl7:qualifier[hl7:name/@code='PREC' and hl7:value/@code='E']]]] and not(hl7:addr[not(@nullFlavor)] and hl7:patient[hl7:name[not(@nullFlavor)] and hl7:birthTime[not(@nullFlavor)]])  
  Komunikat Dla dokumentu realizacji recepty elektronicznej wymagane jest podanie imienia i nazwiska pacjenta, jego adresu oraz daty urodzenia.  
Dołączony 1 … 1 M z 2.16.840.1.113883.3.4424.13.10.2.84 [2] Autor dokumentu realizacji recepty (DYNAMICZNE)
hl7:author
1 … 1 M (plCdotsnse)
@typeCode
0 … 1 F AUT
@contextControlCode
0 … 1 F OP
hl7:templateId
II 1 … 1 M (plCdotsnse)
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.13.10.2.84
hl7:functionCode
CE 1 … 1 R (plCdotsnse)
  CONF
Wartość @code musi pochodzić ze zbioru wartości 2.16.840.1.113883.3.4424.13.11.23 Zawód medyczny uprawniony do wystawiania dokumentu realizacji recepty (DYNAMICZNE)
hl7:time
TS 1 … 1 M (plCdotsnse)
  Schematron assert rola red error  
  test (@value=/hl7:ClinicalDocument/hl7:legalAuthenticator/hl7:time/@value) or (@value=/hl7:ClinicalDocument/hl7:authenticator/hl7:time/@value)  
  Komunikat Data utworzenia dokumentu powinna być taka sama jak data wystawienia lub autoryzacji dokumentu.  
hl7:assignedAuthor
1 … 1 R (plCdotsnse)
@classCode
0 … 1 F ASSIGNED
Wybór 1 … 1 Elementy do wyboru z:
  • hl7:id[@root='2.16.840.1.113883.3.4424.1.6.1']
  • hl7:id[@root='2.16.840.1.113883.3.4424.1.1.616']
hl7:id
II 0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.1.6.1']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.1.6.1
@extension
st 1 … 1 R
hl7:id
II 0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.1.1.616']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.1.1.616
@extension
st 1 … 1 R
  Schematron report rola red error  
  test @root='2.16.840.1.113883.3.4424.1.1.616' and not(matches(string(@extension),'^[0-9]{11}$'))  
  Komunikat Jeżeli identyfikatorem jest numer PESEL, to musi zawierać 11 cyfr.  
hl7:addr
AD 0 … * (plCdotsnse)
hl7:telecom
TEL 0 … * (plCdotsnse)
hl7:assignedPerson
1 … 1 Zawiera 2.16.840.1.113883.3.4424.13.10.2.1 [2] Osoba (bazowy) (DYNAMICZNE) (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:templateId [@root='2.16.840.1.113883.3.4424.13.10.2.1']]
hl7:representedOrganization
0 … 1 Zawiera 2.16.840.1.113883.3.4424.13.10.2.31 [2] Apteka (bazowy) (DYNAMICZNE) (plCdotsnse)
treeblank treeblank treeblank gdzie [hl7:templateId [@root='2.16.840.1.113883.3.4424.13.10.2.31']]
Dołączony 0 … 1 z 2.16.840.1.113883.3.4424.13.10.2.44 [2] Dane umowy związanej z refundacją (DYNAMICZNE)
extPL:boundedBy
0 … 1 (plCdotsnse)
@typeCode
cs 1 … 1 F PART
extPL:templateId
II 1 … 1 M (plCdotsnse)
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.13.10.2.44
extPL:reimbursementRelatedContract
1 … 1 M (plCdotsnse)
@classCode
cs 1 … 1 F CNTRCT
@moodCode
cs 1 … 1 F EVN
Wybór 1 … 1 Elementy do wyboru z:
  • extPL:id[@nullFlavor='NA']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.1']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.2']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.3']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.4']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.5']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.6']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.7']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.8']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.9']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.10']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.11']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.12']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.13']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.14']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.15']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.1.16']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.1']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.2']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.3']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.4']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.5']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.6']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.7']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.8']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.9']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.10']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.11']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.12']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.13']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.14']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.15']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.2.16']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.1']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.2']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.3']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.4']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.5']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.6']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.7']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.8']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.9']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.10']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.11']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.12']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.13']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.14']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.15']
  • extPL:id[@root='2.16.840.1.113883.3.4424.8.6.3.16']
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@nullFlavor='NA']
@nullFlavor
cs 1 … 1 F NA
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.1']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.1
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.2']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.2
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.3']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.3
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.4']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.4
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.5']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.5
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.6']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.6
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.7']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.7
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.8']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.8
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.9']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.9
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.10']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.10
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.11']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.11
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.12']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.12
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.13']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.13
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.14']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.14
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.15']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.15
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.1.16']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.1.16
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.1']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.1
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.2']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.2
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.3']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.3
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.4']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.4
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.5']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.5
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.6']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.6
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.7']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.7
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.8']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.8
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.9']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.9
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.10']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.10
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.11']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.11
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.12']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.12
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.13']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.13
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.14']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.14
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.15']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.15
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.2.16']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.2.16
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.3.1']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.3.1
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.3.2']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.3.2
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.3.3']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.3.3
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.3.4']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.3.4
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.3.5']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.3.5
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.3.6']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.3.6
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.3.7']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.3.7
@extension
st 1 … 1 R
extPL:id
0 … 1 (plCdotsnse)
treeblank treeblank treeblank treeblank treeblank treeblank gdzie [@root='2.16.840.1.113883.3.4424.8.6.3.8']
@root
uid 1 … 1 F 2.16.840.1.113883.3.4424.8.6.3.8
@extension
st 1 … 1 R